Tracheotomy

From ArticleWorld

A tracheotomy is a surgical procedure that involves opening a direct airway by using an incision in the trachea. The incision is semipermanent or permanent, and the term tracheostromy, although used interchangeably with tracheotomy, is sometimes used for the resulted opening itself.

Indications

Tracheotomies are commonly performed in two cases:

• Acute setting, in the case of a severe facial injury, a large tumor of the head and neck, acute neck inflammation and other conditions that obstruct the bloodflow through the nose and towards the lungs.

• Chronic setting, when the condition requires mechanical ventilation for a longer time, like during surgeries performed on the head or neck of a patient.

In some cases, a mini-tracheostomy may be preferred.

Procedure

The procedure of tracheotomy should be performed only by trained medical personnel, as the initial bleeding may be enough to impair the airflow through the incision and cause more complications. The first step involves performing a curvilinear skin incision, followed by a vertical incision that divides the strap muscles. The thyroid isthmus is then divided as well, and the cricoid is elevated using a cricoid hook.

The tracheal incision is then performed. This often involves the usage of a Bjork flap, which is sutured to the inferior skin margin. The usage of a Bjork flap is not compulsory. In fact, some tracheotomies (especially those performed in children) are vertical and do not require them. A tracheostomy tube is inserted and secured in place. The tube is then connected to the ventilator tubing.

If the situation is urgent and the equipment is not present, a simple, horizontal incision may be enough for a tracheotomy.

Complications

Complications may include pneumothorax, blood vessels injury and severe bleeding, respiratory arrest, pulmonary edema, torrential bleeding from tracheoinnominate fistula and tracheal stenosis. Nevertheless, tracheotomies are commonly performed.